MEDICARE: CHRISTINA BOHYOUNG PARK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH59128	CA
2	183500000X	Pharmacist	15301	NV
3	183500000X	Pharmacist	PH-1829	HI

General Provider Information

NPI Number	:	1770775694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA BOHYOUNG PARK

Provider Business Mailing Address
First Line	:	3545 WILSHIRE BLVD
Second Line	:	#200
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2354
Country	:	US
Telephone Number	:	213-385-2135
Fax Number	:

Provider Business Practice Location Address
First Line	:	3545 WILSHIRE BLVD STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2378
Country	:	US
Telephone Number	:	213-385-2135
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	06/30/2011

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Directions to “ CHRISTINA BOHYOUNG PARK ” Practice Location

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